Patient may acquire infection before admission to the hospital = Community acquired infection.Patient may get infected inside the hospital = Nosocomial infection.(HAI)It includes infections not present nor incubating at admission, infections that appear more than 48 hours after admission, those acquired in the hospital but appear after discharge also occupational infections among staff. Dr.T.V.Rao MD 2
Nosocomial infections occur worldwide. The incidence is about 5-8% of hospitalized patients, 1/3 of which is preventable. The highest frequencies are in East Mediterranean and South-East Asia. A high frequency of N.I. is evidence of poor quality health service delivered. Dr.T.V.Rao MD 3
Direct contact with blood or body fluids Indirect contact with a contaminated instrument or surface Contact of mucosa of the eyes, nose or mouth with droplets or spatter Inhalation of airborne microorganisms 4
Other UTI 27% 23%Blood 6% Skin Lower (May, 2000) 10% Wound respiratory 11% 23%
Infection control is a term used thatdescribes ways we can prevent thespread of infection.
Infections can causepain, suffering and often, permanent scarring. In the worst cases, death can occur. Infections cause extra days in the hospital and lead to higher costs for patients and their families.
INFECTION CONTROL PROGRAMThe important components are :1) Basic measures i.e. standard and additional precautions2) Education and training of healthcare workers3) Protection of healthcare workers e.g. immunization4) Identification of hazards and minimizing risks5) Routine practices such as aseptic techniques, handling and use of blood and blood products, waste management, use of single use devices6) Surveillance7) Incident monitoring8) Research Dr.T.V.Rao MD 10
There are three principal goals for hospital infection control and prevention programs:1. Protect the patients2. Protect the health care workers, visitors, and others in the healthcare environment.3. Accomplish the previous two goals in a cost effective and cost efficient manner, whenever possible.. Dr.T.V.Rao MD 11
1. Review and approve surveillance and prevention program2. Identify areas for intervention3. To assess and promote improved practice at all levels of health facility.4. To ensure appropriate staff training5. Safety management6 Development of policies for the prevention and control of infection7. To develop its own infection control manual8. Monitor and evaluate the performance of program Dr.T.V.Rao MD 12
Hospital ProgramInfection Conrtol Team Infection control committee Infection control manual Dr.T.V.Rao MD 13
To review and approve the annual plan for infection control To review and approve the infection control policies. To support the IC team and direct resources to address problems as identified To ensure availability of appropriate supplies To review epidemiological surveillance data and identify area for intervention. Dr.T.V.Rao MD
To assess and promote improved practice at all levels of the health care facility To ensure appropriate training in infection control and safety. To review risks associated with new technology and new devices prior to their approval for use. To review and provide input into an outbreak investigation Dr.T.V.Rao MD
Aiming at preventing spread of infection:Standard precautions: these measures must be applied during every patient care, during exposure to any potentially infected material or body fluids as blood and others. Components: A. Hand washing. B. Barrier precautions. C. Sharp disposal. D. Handling of contaminated material. Dr.T.V.Rao MD 16
Use of water and antimicrobial soap (germ killing soap) and washing for at least 15 seconds.Use of an alcohol based hand rub
Before having direct patient contact Before wearing sterile gloves and inserting a central venous catheter Before inserting urinary catheters, peripheral vascular catheters (IVs), or other invasive devices After contact with a patient’s intact skin such as taking a blood pressure or lifting a patient After contact with body fluids, excretions, mucous membranes, nonintact skin, and wound dressings If moving from a contaminated body site to a clean-body site After contact with objects in the immediate area of the patient (such as medical equipment) After removing gloves
Model good hand washing/hand hygiene practices ˙ Encourage others to do the same ˙ Maintain hand hygiene supplies for your area ˙ Maintain soap and paper products for your areaDr.T.V.Rao MD 20
Taylor (1978) identifiedthat 89% of the handsurface was missed andthat the areas of thehands most oftenmissed were the finger-tips, finger-webs, thepalms and the thumbs.
PPE when contamination or splashing with blood or body fluids is anticipated Disposable gloves Plastic aprons Face masks Safety glasses, goggles, visors Head protection Foot protection Fluid repellent gowns (May, 2000)
Prevention correct disposal in appropriate container avoid re-sheathing needle avoid removing needle discard syringes as single unit avoid over-filling sharps container Management follow local policy for sharps injury
Sepsis - harmful infection by bacteria Asepsis - prevention of sepsis Minimise risk of introducing pathogenic micro-organisms into susceptible sites Prevent transfer of potential pathogens from contaminated site to other sites, patients or staff Follow local policy
Another way to prevent the spread of infectious disease is to place the infectious patient on special precautions or “isolation”. The type of precautions depends upon how the infection is spread.
Contact Precautions are used to prevent infections spread by touching an infected or contaminated body site (direct contact) or by handling objects in the environment that are contaminated (indirect contact). Gastrointestinal (GI) infections such as rotavirus and antibiotic resistant germs such as Oxacillin Resistant Staphylococcus aureus (ORSA)can be spread this way. Gowns and gloves will be needed if providing direct care.
Droplet Precautions are used when a patient has a disease spread by respiratory droplets. The infectious droplets are released when the patient sneezes or coughs. Since droplets are heavy, they fall rapidly usually within 3 feet of the patient. Whooping cough and meningococcal meningitis are examples of diseases spread this way. A private room is used and all persons entering must wear a surgical mask.
Airborne Precautions are used to prevent infections spread through the air. Unlike droplets, the germs involved with airborne diseases are so small that they can remain in the air for long periods of time and float on air currents. Tuberculosis, varicella (chickenpox) and measles are airborne diseases.
Protective Precautions are used for patients who are at high risk for acquiring infection. A private room is used with special ventilation that prevents air from flowing from the hallway into the room (positive pressure room). Staff and visitors must perform hand hygiene before entering the room and persons should not enter the room if they are Sick Read the posted sign because at times special garments or gloves are required before entry.
Let’s look at some other importantinfection control practices.
Patient care items must be stored in a clean location at least 8 inches above the floor Patient care items must not be stored in under-sink cabinets. Since some items have expiration dates, it is important to establish a routine for checking dates.
Monitor and maintain temperature between 2 and 8 degrees C Keep food/nourishments in a separate refrigerator from medications/IV fluidsNEVER place lab specimens in a medication or nourishment refrigerator
Regular hospital waste is placed in black trash bags.Remember, before discarding items in the regular trash:I. Empty fluid-filled containers such as IV bags and tube feedingsII. Remove any labels which have the patient’s name and/or medical record number
Malaysian law requires that certain medical waste be incinerated. Regulated medical waste must be placed in yellow trash bags. Examples of regulated medical waste include:I. Full sharps containersII. >20ml blood or blood products that cannot be easily emptied (e.g., pleurevacs, blood administration tubing, evacuated containers)III. Microbiology and Pathology specimensIV. Items used in the preparation and administration of hazardous drugs
Many patient care devices and items are designed to be used with one patient and often only one time. These items are considered disposable and must not be resterilized or reused.Read the manufacturer’s directions to be sure how a device is intended to be used.
Reusable patient care devices/items must be properly cleaned and disinfected following STRICT guidelines. Unless an item has been thoroughly cleaned, disinfection cannot occur. Health care workers responsible for cleaning and disinfecting reusable patient items must be trained in these procedures.
Hospital construction generates dust and debris. Construction dust, including dust released from the removal of ceiling tiles, may contain molds that can cause serious infections in high risk patients. Plastic and solid wall barriers are designed to prevent movement of dust outside the construction site. Contact your supervisor or an Infection Control Professional to report barriers that appear damaged. Remember, only authorized personnel should enter a construction site.
Bedmaking and linen changing techniques Gloves and apron - handling contaminated linen Appropriate laundry bags Avoid contamination of clean linen Hazards of on-site ward-based laundering
PPE - disposable gloves, apron Soak up with paper towels, kitchen roll Cover area with hypochlorite solution e.g., Milton, for several minutes Clean area with warm water and detergent, then dry Treat waste as clinical waste - yellow plastic sack